Paperless Medicine

Paperless Medicine

Doctors use surprisingly low tech ways to keep track of patient information-sometimes with fatal results. Despite high costs and cultural barriers, electronic record keeping is starting to bring medicine into the digital age.

Doctors’ lousy handwriting is infamous. Every day pharmacists stop customers to ask them what their prescriptions say, and patients pick up orders only to find that they’ve been given the wrong dosage or even the wrong drug. But those pharmacist misreads can mean more than mere hassles.

In a 1999 study, the Institute of Medicine reported that in 1993, almost 7,400 Americans died from medication errors. A decade later, such errors are still a major problem. GlaxoSmithKline, for example, has posted a notice on its Web site warning that patients with prescriptions for its antiseizure drug Lamictal have mistakenly received Lamisil (a medication for fighting nail fungus), Lomotil (an antidiarrheal), Ludiomil (an antidepressant), and other medications-sometimes with dire consequences.

One basic change-using computers to order prescriptions-has reduced medication errors by as much as 80 percent in some hospitals. Motivated by such life-and-death statistics, a growing though still-small number of doctors and hospitals are weaning themselves from paper, using computers not just to order prescriptions and lab tests but also to track patients’ conditions, medications, allergies, and test results. “We could make tremendous advances in improving health care with the technology that we have in hand,” says Gilad Kuperman, associate director of clinical informatics research and development for Partners Healthcare System in Boston.

Those advances would be a welcome change from the messy, difficult-to-track record keeping that prevails in health care today. Typically, the primary care physician keeps one set of records, hospitals another, and each specialist yet another. And all of these medical histories are logged in old-fashioned paper “charts.” Any information a patient forgets to tell one of his or her doctors-about a severe allergy to a medication, say,-simply doesn’t appear in that doctor’s record.

Indeed, much of the nation’s health-care system is entering the information age kicking and screaming. While Amazon.com and grocery chains compile detailed records of customers’ buying habits, only about 5 percent of U.S. primary care doctors store information about their patients electronically. Resistance to adopting the technology abounds, rooted in doctors’ unwillingness to abandon decades-old ways of doing things and a perception that the benefits to the practitioners are not worth the costs. “McDonald’s has a better record of what they’ve served all their customers than we have of our patients’ medical histories,” says Isaac Kohane, a Harvard University medical informatics specialist and endocrinologist.

Still, the medical world hasn’t been able to entirely ignore the cheap and plentiful computing power and networking technologies developed over the past decade. The U.S. Department of Veterans Affairs now uses electronic records at each of its 163 hospitals, many of which are now essentially paperless. Increasing numbers of private hospitals and medical systems are implementing computerized patient records as well. About 1,500 primary care physicians and 11 hospitals use Partners Healthcare’s medical records system to keep track of several hundred thousand patients. And in February, Kaiser Permanente, the nation’s largest HMO, announced that over the next three years it would implement electronic records for all its 8.4 million members. As more doctors begin to train and work in such hospitals and realize the benefits of their systems, the hurdles to even wider adoption may slowly disappear. And as new genetic information drives medicine toward data dependence, electronic health records will become more than beneficial-they will be absolutely necessary. The medical databases of the 21st century will join the anesthesia of the 19th century and the antibiotics of the 20th as indispensable medical tools.